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Learning to Swim in The Alphabet Soup of the DSM

Alphabet Soup

If you’ve been identified as anything according to the DSM-IV (and soon to be DSM-V), then you might have had the experience of being reduced to a series of letters and possibly numbers in your exchanges with your insurance company and mental healthcare providers–alphabet soup. If you started out being poked and prodded by the mental healthcare system as a child, then you’ll likely have something rivaling the entire Roman numeral system and alphabet from A to Z in your medical records because children’s brains are in a rather dynamic state–always changing–hence, the diagnostic codes and labels are always changing, too. Grace dipped her toe into this soupy goodness when she was 7 years-old. She was pushed in when she was 10. These are the letters in her soup bowl so far.

ADHD: Attention Deficit Disorder, Inattentive Type. Grace was diagnosed with this when she was 7 years-old. This was an inaccurate diagnosis but not uncommon for emerging mood disorders. Executive function problems often manifest as ADHD, Inattentive Type, and executive function problems can be symptomatic of mood disorders specifically bipolar disorder and schizophrenia spectrum disorders.

LD/NS: Learning Disorder, not specified. Grace was also diagnosed with a learning disorder that wasn’t specified meaning that it wasn’t classified specifically. She, however, couldn’t read…at all. As a second grader. I would guess that this LD could be attributed to her now known issues with working memory. It hovers around the 3rd percentile.

MDD: Major Depressive Disorder. Grace has not responded quickly to pharmaceutical help. She’s been consistently depressed since 2011. Even when she’s manic she still displays depressive symptoms which puts her in a mixed state. It’s an odd diagnosis to be sure–an MDD with a bipolar diagnosis. This will, no doubt, change as she develops.

AD/NS: Anxiety Disorder, not specified. This diagnosis seems to hang around regardless of who is assessing Grace. She is, however, consistently paranoid which causes me to wonder if that isn’t contributing to her anxiety. I know I would be anxious.

BD/NOS: Bipolar Disorder-Not Otherwise Specified. This essentially means that she’s displaying symptoms consistent with bipolar disorder, but she’s still too young to determine if she’s going to be Bipolar Type I or Type II. Of course, it’s a spectrum, and she is displaying psychotic features. This is where the Schizoaffective Disorder diagnosis comes into play.

COS: Childhood-onset Schizophrenia. Grace was diagnosed with a schizophrenia spectrum disorder. In the world of psychiatric nosology, I’m discovering that this is, well, unclear. There’s a bit of overlap and conjecture in the field. For now, it’s being called Schizoaffective Disorder on paper and schizophrenia spectrum disorder when I’m sitting in the doctor’s office. Either way, it’s treated the same way regardless of the terminology.

GAD: Generalized Anxiety Disorder. This diagnosis seems to be a variation on a theme. Here is something important to remember. The brain likes things to be consistent. If the brain produces an image, then that image ought to stay there. It shouldn’t come and go as it pleases. So, if the parietal lobe produces an image of Grace’s father in the kitchen and then, suddenly, he disappears right before Grace’s eyes, Grace’s brain will experience anxiety. Grace will begin to question what else is real in her world. Are the cats real? What about that guy sitting in the chair in the corner in the café? Psychosis breeds anxiety, and I do wonder if clinicians truly understand that.